TY - JOUR
T1 - Prehospital disaster triage does not predict pediatric outcomes
T2 - Comparing the criteria outcomes tool to three mass-casualty incident triage algorithms
AU - Cicero, Mark X.
AU - Santillanes, Genevieve R.
AU - Cross, Keith P.
AU - Kaji, Amy H.
AU - Donofrio, J. Joelle
N1 - Publisher Copyright:
© 2021 Authors
PY - 2021/10/16
Y1 - 2021/10/16
N2 - Introduction: It remains unclear which mass-casualty incident (MCI) triage tool best predicts outcomes for child disaster victims. Study Objectives: The primary objective of this study was to compare triage outcomes of Simple Triage and Rapid Treatment (START), modified START, and CareFlight in pediatric patients to an outcomes-based gold standard using the Criteria Outcomes Tool (COT). The secondary outcomes were sensitivity, specificity, under-triage, over-triage, and overall accuracy at each level for each MCI triage algorithm. Methods: Singleton trauma patients under 16 years of age with complete prehospital, emergency department (ED), and in-patient data were identified in the 2007-2009 National Trauma Data Bank (NTDB). The COT outcomes and procedures were translated into ICD-9 procedure codes with added timing criteria. Gold standard triage levels were assigned using the COT based on outcomes, including mortality, injury type, admission to the hospital, and surgical procedures. Comparison triage levels were determined based on algorithmic depictions of the three MCI triage tools. Results: A total of 31,093 patients with complete data were identified from the NTDB. The COT was applied to these patients, and the breakdown of gold standard triage levels, based on their actual clinical outcomes, was: 17,333 (55.7%) GREEN; 11,587 (37.3%) YELLOW; 1,572 (5.1%) RED; and 601 (1.9%) BLACK. CareFlight had the best sensitivity for predicting COT outcomes for BLACK (83% [95% confidence interval, 80%-86%]) and GREEN patients (79% [95% CI, 79%-80%]) and the best specificity for RED patients (89% [95% CI, 89%-90%]). Conclusion: Among three prehospital MCI triage tools, CareFlight had the best performance for correlating with outcomes in the COT. Overall, none of three tools had good test characteristics for predicting pediatric patient needs for surgical procedures or hospital admission.
AB - Introduction: It remains unclear which mass-casualty incident (MCI) triage tool best predicts outcomes for child disaster victims. Study Objectives: The primary objective of this study was to compare triage outcomes of Simple Triage and Rapid Treatment (START), modified START, and CareFlight in pediatric patients to an outcomes-based gold standard using the Criteria Outcomes Tool (COT). The secondary outcomes were sensitivity, specificity, under-triage, over-triage, and overall accuracy at each level for each MCI triage algorithm. Methods: Singleton trauma patients under 16 years of age with complete prehospital, emergency department (ED), and in-patient data were identified in the 2007-2009 National Trauma Data Bank (NTDB). The COT outcomes and procedures were translated into ICD-9 procedure codes with added timing criteria. Gold standard triage levels were assigned using the COT based on outcomes, including mortality, injury type, admission to the hospital, and surgical procedures. Comparison triage levels were determined based on algorithmic depictions of the three MCI triage tools. Results: A total of 31,093 patients with complete data were identified from the NTDB. The COT was applied to these patients, and the breakdown of gold standard triage levels, based on their actual clinical outcomes, was: 17,333 (55.7%) GREEN; 11,587 (37.3%) YELLOW; 1,572 (5.1%) RED; and 601 (1.9%) BLACK. CareFlight had the best sensitivity for predicting COT outcomes for BLACK (83% [95% confidence interval, 80%-86%]) and GREEN patients (79% [95% CI, 79%-80%]) and the best specificity for RED patients (89% [95% CI, 89%-90%]). Conclusion: Among three prehospital MCI triage tools, CareFlight had the best performance for correlating with outcomes in the COT. Overall, none of three tools had good test characteristics for predicting pediatric patient needs for surgical procedures or hospital admission.
KW - child
KW - injuries
KW - mass-casualty incidents
KW - triage
UR - http://www.scopus.com/inward/record.url?scp=85113190744&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85113190744&partnerID=8YFLogxK
U2 - 10.1017/S1049023X21000856
DO - 10.1017/S1049023X21000856
M3 - Article
C2 - 34392857
AN - SCOPUS:85113190744
SN - 1049-023X
VL - 36
SP - 503
EP - 510
JO - Prehospital and Disaster Medicine
JF - Prehospital and Disaster Medicine
IS - 5
ER -